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Cupping Therapy-induced Iron Deficiency Anemia in a Healthy Man

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... Sixteen single case reports were identified and included in this review for analysis. The most frequently reported AEs of cupping therapy were three cases of anemia [11,12,20], three cases of bullae [16,17,21]. The other single case studies that reported adverse effects of cupping therapy were: two cases of scar [4,7], two cases of Köebner phenomenon [23,25], and each one a case of hyperpigmentation [14], stroke [5], herpes simplex virus [10], cervical epidural abscess [13], cutaneous mycobacterium infection [15], factitious panniculitis [18], lumbar abscess [22], lipoma [19], and acquired hemophilia [24]. ...
... Two studies reported qualified therapists [13,19], two studies reported doing cupping by patients themselves (auto-cupping) [18,20] and one by unqualified therapist [11]. There was one case that used massage cupping [19], four patients used wet cupping [12,13,20,22], and fourteen cases used dry cupping method. In eleven cases, cupping therapy was used to treat various types of musculoskeletal pains, and the most frequently reported musculoskeletal pain was the back pain in five case reports [7,11,14,21,22]. ...
... Evidently, the mostly observed AEs related to cupping therapy were scar formation [4,7,8,27], followed by burns [6,9]. The less frequently observed AEs were headache [27], pruritis at the site of cupping or whole body [8,27,29], dizziness [27], feeling tired [27], feeling sleepy [27], increase in pain, muscle tension or soreness [27,28,30], anemia [11,12,20], nausea [27], bullae formation [16,17,21], small hematoma or pain at cupping site [27][28][29], cervical and lumber abscess formation [13,22], skin infection by herbs simplex [10] and mycobacterium [15], insomnia [27], and stroke [5], panniculitis [18], acquired hemophilia [24], lipoma [19], skin laceration [29], hyperpigmentation [14,27] and vasovagal attack [27]. The frequencies of these adverse effects were variable in these observational studies and RCTs. ...
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Background: Cupping therapy is a well-known traditional treatment modality, and has been used in various diseases around the world since ancient times. This method is reported to have a better clinical as well as adverse events (AEs) profile as found in various studies conducted around the world. Aim: This study identifies, assesses, and classifies the adverse events profile of various types of cupping therapies in studies conducted in twenty one century. Methods: Using electronic and hand searches, three databases including Pub Med, Google Scholar and Cochrane library were searched from the year 2000 to 2016. Studies were included in this review provided they reported adverse effects related to cupping therapy. Observational studies were assessed using the WHO-UMC causality scale. Randomized controlled trials were assessed in accordance to the quality of reporting for harm data. Results: Nine hundred seventy nine (n=979) articles were identified. Based on exclusion and inclusion criteria and extensive review of all retrieved articles by two independent reviewers, only 25 studies that included six RCTs, sixteen single case reports and three case series were finally selected. The mostly observed adverse events of cupping therapy were scar formation reported in four studies that described fifty nine cases, and burns reported in two studies described sixteen cases, respectively. The adverse events of cupping therapy could be classified into local and systemic adverse events. Conclusion: Cupping therapy adverse events were infrequently reported, but they were not rare. Most of adverse effects were mild to moderate in severity. Some of the cupping therapy adverse events were preventable by following the general infection control guidelines, hygienic techniques, safety protocols and rigorous training of cupping therapists. Cupping adverse events should be reported in all studies on cupping, and this therapy should be practiced only by qualified medical professionals.
... Among 28 studies, there were three single case studies, twelve case studies, six case controlled trials (CCTs), two surveys, one qualitative research and four RCTs. Finally, 16 studies, including two cross-sectional surveys [4,11], one prospective audit [12], nine single-case studies and one case series [13][14][15][16][17][18][19][20][21][22], as well as three RCTs (or quasi-RCTs) [3,23,24], were included in the final review (Fig. 1). ...
... Cupping was practiced by the patient himself (or herself) in three cases [18,20,22], by KMDs in three cases [13,18,19], and by an unqualified person in two cases [15,21]. Three studies did not report on the personnel who administered the cupping treatment [14,16,17]. The cupping method described in the case studies was mainly wet cupping [17][18][19]21,22], and only one case study reported AEs related to dry cupping [15]. ...
... Three studies did not report on the personnel who administered the cupping treatment [14,16,17]. The cupping method described in the case studies was mainly wet cupping [17][18][19]21,22], and only one case study reported AEs related to dry cupping [15]. The severity of the AEs reported was moderate to severe. ...
Article
Aims To assess the adverse events (AEs) related to cupping therapy identified from studies conducted in Korea. Methods Four Korean databases were searched from their inception to April 2013. We also searched PubMed and the Cochrane Library for literature from Korea. Regardless of the patient's condition, disease status, and study design, all studies were included in this review if they reported any AEs related to cupping therapy. If a case study was identified, causality was assessed through the WHO-UMC causality scale. In addition, if any randomized controlled trials (RCTs) were located, the quality of the reporting of AEs was evaluated. Results Abstracts were retrieved for the 572 articles identified through the searches as having a relevant title which could be included in the review. Among them, a total of 16 studies were included in this review. Articles included various study designs; cross-sectional surveys, a prospective audit, case studies or series, and RCTs (or quasi-RCTs). Anemia (n = 5), factitial panniculitis (n = 2), and herpes viral infection (n = 2) were the most frequently reported AEs in the observational studies. The results from the RCTs indicated that AEs related to cupping were infrequent. Conclusions Various AEs related to cupping therapy were reported but were rare. Most of the AEs were avoidable, if trained personnel provided the treatment. Cupping should be administered by qualified medical experts and in compliance with safety guidelines. In addition, future clinical trials using cupping should pay more attention to recording AEs directly related to cupping to identify potential risks.
... We have found six such case reports in the literature with similar stories of a patient who developed anaemia and even some had anaemia with complications following an excessive course of wet cupping-and, in one case, dry cupping. Five of those case reports or case series were for Korean patients [2][3][4][5] and one was from Turkey [6]. All those cases had a common history of performing what was described as repeated, excessive, or long-duration cupping. ...
... Clearly those results are different from the case reports that were listed previously. They all reported very frequent wet or dry cupping for a long duration followed by the patients suffering from anaemia [2][3][4][5][6]. Therefore, the anaemia might be due to the unusual excessive cupping sessions that were done in those reports. ...
Article
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Although wet cupping is quite a popular procedure that is practised worldwide, there is not enough evidence that it may cause anaemia as a side effect. In this observational retrospective pre–post study, we looked through the previously recorded data of patients who received wet cupping at King Abdulaziz University Hospital. We included in the study all those who had their complete blood count done before and immediately after the procedure (n=364). Then, we recorded their blood haemoglobin, red blood cell count, mean corpuscular volume, mean corpuscular haemoglobin and haematocrit before wet cupping, immediately after it, within 3 months after it, then, finally, from 3 months to 6 months after it. Three comparisons took place for each blood test by comparing the pre-reading with each one of the three post-readings. There was no statistically significant difference in any of the pre–post comparisons of those blood tests. However, after excluding those who were not anaemic and keeping only the anaemic patients, the comparison showed statistically significant improvement, but not clinically significant, when comparing the red blood cell count and the haematocrit before and immediately after wet cupping — p value was 0.000 for both. The mean difference for red blood cell count was –0.80 million cells/L (–0.12 to –0.39) while the haematocrit mean difference was –0.64% (–0.96 to –0.33). In conclusion, anaemia was not found as a side effect of wet cupping.
... secondary amenorrhoea [45] and stroke rehabilitation. [46] Cupping therapy was reported to reduce serum iron [47] and ferritin [1] in healthy subjects. Recently, Al-hijamah was reported to treat effectively some dermatological conditions e.g. ...
... Interestingly, Al-hijamah may confer some therapeutic benefits similar to that exerted by many drugs e.g. vasodilator effect (Al-hijamah treats ischemia through release of NO), [2,12,13] antihypertensive effect (Alhijamah decreases both systolic and diastolic blood pressure), [1] hypolipidemic effect (Al-hijamah decreases serum triglycerides, total cholesterol and LDL-cholesterol) [1], immunostimulant effect (Al-hijamah enhances natural immunity), [16] iron-lowering effect (Al-hijamah reduces serum ferritin [1] while excessive WCT causes iron deficiency), [20,21,47] excretory effect to bacteria and toxins in blood (CT treats cellulitis), [17] analgesic effect (treats headache, migraine [35] and releases endogenous opioids), [2,3] angiogenic effect (improves capillary circulation), [2,3] urate clearance effect (Al-hijamah reduced uric acid), [1] anti-neoplastic effect (Al-hijamah clears blood chemistry of cancer patients from growth factors and cancer-related products in addition to the role of released NO). [2,3,70] Interestingly, there is no chance for occurrence of antagonism among those pharmacological effects of Al-hijamah with different pharmacological treatments as Al-hijamah is a mechanical procedure where no chemical interaction will develop. ...
Article
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Excretory treatment modalities that excrete pathological substances outside human body deserve more research attention as this may potentiate the therapeutic effects of pharmacological treatments. Overcoming language barrier through translating the national medical literature to medical English to be introduced to the international medical literature is vital. Wet cupping therapy (WCT) of prophetic medicine (Al-hijamah) is practiced in the Arabic medical literature where it is reported to treat many diseases differing in etiology and pathogenesis. Al-hijamah may be referred to as bloodletting cupping therapy or blood cupping therapy in medical studies and reports from Arabic countries. Both Chinese dry cupping therapy and WCT are partial steps of Al-hijamah. In this article, we review scientific principles, methodology, indications and therapeutic benefits of Al-hijamah in comparison with acupuncture and other types of cupping therapy. Scientific and medical bases of Al-hijamah were recently reported in the evidence-based Taibah mechanism (Taibah theory) where Al-hijamah is the only excretory treatment that clears blood, lymph and intercellular fluids from causative pathological substances (CPS). Al-hijamah benefits from the histological structure of the skin in performing a percutaneous pressure-dependent and size-dependent non- specific blood filtration and excretion of CPS through the fenestrated skin capillaries upon application of negative pressure suction using sucking cups. Al-hijamah benefits also from the production of endogenous nitric oxide (vasodilator, antineoplastic and antimicrobial agent). Al-hijamah exerts many other health benefits e.g. enhancement of immunity and pharmacological potentiation. Al-hijamah was reported to clear blood significantly from serum triglycerides, total cholesterol, LDL-cholesterol, ferritin (circulating iron stores), uric acid, autoantibodies, cytokine receptors and others. Those therapeutic benefits may treat some diseases e.g. hyperlipidemia, hypertension, atherosclerosis, coronary heart diseases, gout, musculoskeletal pain conditions, hepatitis and iron overload conditions e.g. thalassemia. Importance of Al-hijamah may increase more in modern societies due to western diets and western life style. Therapeutic benefits of Al-hijamah are mainly related to the amount of excreted CPS not the amount of letted blood. Al-hijamah may carry some advantages better than acupuncture and other types of cupping therapy in treating a large number of diseases differing in etiology and pathogenesis.
... Interestingly, excessive WCT (PC method) was reported to cause iron deficiency anemia [76][77][78]. The beauty of WCT comes from the fact that WCT is a simple, effective, repeatable and economic treatment. ...
... The little amount of traumatic blood cells lost during skin scarifications of WCT step is too minimal to cause anemia (Table 1). However, excessive WCT (PC method) by unqualified practitioners was reported to cause iron-deficiency anemia [76][77][78]. Moreover, WCT clears fragmented RBCs, liberated hemoglobin (source of iron overload), high levels of ferritin and other hemolyzed cells. ...
Article
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Iron overload is a big challenge when treating thalassemia (TM), hemochromatosis and sideroblastic anemia. It persists even after cure of TM with bone marrow transplantation. Iron overload results from increased iron absorption and repeated blood transfusions causing increased iron in plasma and interstitial fluids. Iron deposition in tissues e.g. heart, liver, endocrine glands and others leads to tissue damage and organ dysfunction. Iron chelation therapy and phlebotomy for iron overload have treatment difficulties, side effects and contraindications. As mean iron level in skin of TM patients increases by more than 200%, percutaneous iron excretion may be beneficial. Wet cupping therapy (WCT) is a simple, safe and economic treatment. WCT is a familiar treatment modality in some European countries and in Chinese hospitals in treating different diseases. WCT was reported to clear both blood plasma and interstitial spaces from causative pathological substances (CPS). Standard WCT method is Al-hijamah (cupping, puncturing and cupping, CPC) method of WCT that was reported to clear blood and interstitial fluids better than the traditional WCT (puncturing and cupping method, PC method of WCT). In other word, traditional WCT may be described as scarification and suction method (double S technique), while Al-hijamah may be described as suction, scarification and suction method (triple S technique). Al-hijamah is a more comprehensive treatment modality that includes all steps and therapeutic benefits of traditional dry cupping therapy and WCT altogether according to the evidence-based Taibah mechanism (Taibah theory). During the first cupping step of Al-hijamah, a fluid mixture is collected inside skin uplifting due to the effect of negative pressure inside sucking cups. This fluid mixture contains collected interstitial fluids with CPS (iron, ferritin and hemolyzed RBCs in thalassemia), filtered fluids (from blood capillaries) with iron and hemolyzed blood cells (hemolyzed RBCs, WBCs and platelets). That fluid mixture does not contain intact blood cells (having diameters in microns) that are too big to pass through pores of skin capillaries (6-12nm in diameter) and cannot be filtered. Puncturing skin upliftings and applying second cupping step excrete collected fluids. Skin scarifications (shartat mihjam in Arabic) should be small, superficial (0.1mm in depth), short (1-2mm in length), multiple, evenly distributed and confined to skin upliftings. Sucking pressure inside cups (-150 to -420mmHg) applied to skin is transmitted to around skin capillaries to be added to capillary hydrostatic pressure (-33mmHg at arterial end of capillaries and -13mmHg at venous end of capillaries) against capillary osmotic pressure (+20mmHg). This creates a pressure gradient and a traction force across skin and capillaries and increases filtration at arterial end of capillaries at net pressure of -163 to -433mmHg and at venous end of capillaries at net pressure of -143 to -413mmHg resulting in clearance of blood from CPS (iron, ferritin and hemolyzed blood cells). Net filtration pressure at renal glomeruli is 10mmHg i.e. Al-hijamah exerts a more pressure-dependent filtration than renal glomeruli. Al-hijamah may benefit patients through inducing negative iron balance. Interestingly, Al-hijamah was reported to decrease serum ferritin significantly (by about 22%) in healthy subjects while excessive traditional WCT was reported to cause iron deficiency anemia. Al-hijamah is a highly recommended treatment in prophetic medicine. In conclusion, Al-hijamah may be a promising adjuvant treatment for iron overload in TM, hemochromatosis and sideroblastic anemia.
... Most were minor: keloid scarring [113], burns [114,115], and bullae [116,117]. Several were serious: acquired hemophilia A [118], stroke 14 hours after cupping on the back and neck [119], factitious panniculitis [120], reversible cardiac hypertrophy [121], and iron deficiency anemia [122]. These last two cases involved cupping with bleeding [121,122]. ...
... Several were serious: acquired hemophilia A [118], stroke 14 hours after cupping on the back and neck [119], factitious panniculitis [120], reversible cardiac hypertrophy [121], and iron deficiency anemia [122]. These last two cases involved cupping with bleeding [121,122]. In six cases, there was no information on practitioner training; in the other four, treatment was self-administered. ...
Article
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Acupuncture, moxibustion, and cupping, important in traditional Eastern medicine, are increasingly used in the West. Their widening acceptance demands continual safety assessment. This review, a sequel to one our team published 10 years ago, is an evaluation of the frequency and severity of adverse events (AEs) reported for acupuncture, moxibustion, and cupping between 2000 and 2011. Relevant English-language reports in six databases were identified and assessed by two reviewers. During this 12-year period, 117 reports of 308 AEs from 25 countries and regions were associated with acupuncture (294 cases), moxibustion (4 cases), or cupping (10 cases). Country of occurrence, patient's sex and age, and outcome were extracted. Infections, mycobacterial, staphylococcal, and others, were the main complication of acupuncture. In the previous review, we found the main source of infection to be hepatitis, caused by reusable needles. In this review, we found the majority of infections to be bacterial, caused by skin contact at acupoint sites; we found no cases of hepatitis. Although the route of infection had changed, infections were still the major complication of acupuncture. Clearly, guidelines such as Clean Needle Technique must be followed in order to minimize acupuncture AEs.
... Cupping is mainly suggested as a complementary therapy in some conditions. These conditions, for instance, include migraine, sports injuries and performance, neck and shoulder pain, muscle pain and soreness, back pain and/or knee pain [10]. It is well known that Hijama is safe when a professional person performs it, especially on healthy individuals [2]. ...
Article
Background: Modern medicine, despite its great advances, still not as effective as cupping therapy in treating many medical conditions. Objective: To assess the level of awareness and the general perceptions about cupping therapy (Hijama) in the Saudi population. Methods: We conducted a cross-sectional study among 1120 adult subjects (473 males and 647 females), during the period from January to March 2020. Participants responded to an anonymous self-administered questionnaire requesting information about their knowledge, attitude, and perceptions of cupping therapy. The data collected from 1120 questionnaires were analyzed using appropriate statistical methods in two stages (descriptive analysis - analysis of the study hypotheses). The frequencies and percentages of the descriptive analysis and the primary data of the study sample were calculated and the responses of its members to the questions included in the questionnaire were determined. The study hypotheses were analyzed using the chi-squared test to study the independence of the variables under study. The analysis was done using (IBM SPSS Statistics 25.0) software. Results: About 32% of the participants underwent cupping before and the majority of them performed wet cupping (82.2%) and felt light pain (55.6%). Almost 60% of all participants were afraid of cupping and this fear was mainly from the injury (37%). The percentage of those who prefer to donate their blood was 72% while only 28% choose to perform cupping. There were statistically significant relationships between the gender of the participants and cupping procedure (p=0.003), fear of performing it (p<0.001) and preference for cupping over donating blood (p=0.002). Similarly, there were statistically significant relationships (p<0.001) between the age of the participants and cupping procedure, fear of performing it and preference for cupping over donating blood. Conclusion: This study showed the high knowledge, attitudes and perception of the Saudi population towards wet cupping therapy. Importantly, most of the surveyed population, especially younger ones, choose to donate their blood rather than performing wet cupping. Further research is needed to establish a collaboration platform between wet cupping clinics and blood banks to fill the gap of frequent shortage of blood units.
... Another study also reported that cupping was effective in shingles-related post-herpetic neuralgia [24]. The most commonly encountered side-effects of cupping include anemia due to excessive bleeding [25,26] and herpes virus infection [27]. Later changes include scarring in the incision site and hyperpigmentation [28]. ...
Article
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Background: Although interest in traditional and complementary medicine (TCM) methods has grown, patients are still reluctant to inform physicians that they employ these. Reasons for the increase in the frequency of TCM methods include interventional procedures being performed less or not at all, and the perception that topical treatment is harmless. The great majority of people who use TCM methods acquire the relevant information from the internet and those around them. Physicians therefore need to be aware of such trends and to protect patients against incorrect use by informing them accordingly. The purpose of this study was to investigate the frequency of the use of TCM methods among patients presenting to the dermatology clinic. Materials and Methods: Patients presenting to the dermatology clinic between June 2018-April 2019, aged over 15, and with symptoms persisting for longer than six weeks was included in the study. Disoriented or uncooperative patients were excluded. Patients agreeing to participate read and signed informed consent forms, after which a question and answer type questionnaire was administered to collect data about TCM applications. Results: Six hundred fifty-one patients, 56.9% of whom were women, took part, and 13.3% had used TCM. Herbal remedies were the most frequently employed method at 67.8%, followed by cupping at 16%, leeches at 13.7%, and moxibustion at 2.2%. Frequency of use was 48.2% among women and 51.8% among men, while in terms of age the frequency was highest in the 45-55 age range, and in terms of education use was highest among university graduates. Conclusion: Patients attending for examination should be given information to protect against misuse of TCM methods by inquiring into their attitudes toward them, especially those failing to benefit from the treatment administered or with recurring symptoms. Physicians must be aware of such tendencies on the part of patients and must inform patients about these methods when necessary.
... One case report describes a 39-year-old male that presented with fatigue and dyspnea on exertion (41). The patient had undergone 6 months of wet cupping for chronic muscular pain. ...
Article
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Cupping is an ancient procedure that has been practiced for thousands of years. It has been used to treat a variety of medical conditions, including dermatological ones. Cupping has been described in the literature for the treatment of conditions such as acne and eczema. The procedure is fundamentally divided into dry cupping and wet cupping; however, there have been many modern adaptations. Adverse events related to the procedure have been reported in the literature and should be considered by patients. However, cupping has a promising role in helping manage dermatological conditions.
... Kupa tedavisinin profesyonellerce uygulanması, anemi oluşmaması için sık aralıklarla yapılmaması, uygulama öncesi hastanın değerlendirilmesi, muayenesinin yapılması ve hemogram, biyokimya gibi tetkiklerinin incelenmesi, enfeksiyon riski açısından emniyet kılavuzunun takibi gerekir. 14,7,57 Uygulama öncesi oluşabilecek yan etki listesi çıkartılarak değerlendirme yapılmalıdır. 58 Kupa uygulaması sonrası erken dönemde eritem, dairesel ekimoz, şişlik, kanama, rahatsızlık hissi, ağrı, hafif başağrısı, terleme, sıcaklık basma hissi ve karıncalanma gözlenebilirken; kesi bölgesinde skar, morarma, hiperpigmentasyon ise daha geç gözlenen değişikliklerdir. ...
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Antik çağlardan bu yana, tamamlayıcı ve geleneksel tedavi, insan sağlığı için önemli bir rol oynamıştır. Tamamlayıcı ve geleneksel tedavi uygulamalarından olan kupa (yaş veya kuru kupa tedavisi) tedavisi konvansiyonel tedaviye cevap vermeyen birçok bozukluklarda terapötik etkiye sahip olduğu iddia edilmektedir. Bu derleme, ilgili literatürün ışığında kupa tedavisi tanımlamasını, tarihçesini, uygulama tekniklerini, mekanizmasını, uygulama bölgelerini ve yan etkilerini özetlemektedir.
... However, if the blisters are severe, liquid is drawn out by a sterile syringe ; gentian violet is applied and covered with gauze to prevent infection. Cases of Panniculitis (Lee et al., 1995 ), bloodletting induced cardiomyopathy (Sohn et al., 2008), Iron deficiency anemia (Lee et al., 2008), Burn (Sagi et al., 1988 and Kose et al., 2006), Acquired haemophilia A (Weng and Hsiao, 2008) have also been reported. Cupping of the cervical area may cause a haemorrhagic stroke by an acute rise in blood pressure (Blunt and Lee, 2010). ...
Article
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Background: Cupping (Hijamah) therapy is very well documented as a result of several thousand years of clinical experiences in Unani medicine. In this procedure, suction is created by various means either with or without bloodletting. Though this therapy is being widely practiced across the globe for treating many chronic and intractable ailments but many reports reveal its unscientific and improper practices which results in many complications. Therefore to develop standard operative procedures and to propose protocols of cupping therapy in various diseases is the need of hour. Materials and methods: Materials and methods: A thorough literature review of relevant journals and textbooks was performed to gather the maximum available data on cupping therapy. Conclusion: This paper seeks to introduce the general concepts of cupping therapy in Unani medicine and other traditional systems of medicine, shortcomings and limitations of the currently published studies and suggest ways to improve these technical/methodological flaws. In addition, the authors have also attempted to provide the cupping related materials, hypotheses, observations which will provide the researchers the base for evaluating their usefulness in future clinical trials.
... The literature contains several case reports from East Asia. One such report describes reversible cardiac hypertrophy in a patient with severe chronic anemia due to long-term bloodletting with cupping and another describes cupping therapy induced iron deficiency anemia [2,3]. In the presented case blood loss from the skin was caused by self-made incisions and bloodletting with cupping. ...
... Complications related to misapplication of wet cupping have been reported as iron deficiency anemia and cardiomyopathy. 8,9 It has also been reported that a cervical epidural abscess may occur after non-hygienic cupping and acupuncture procedures. 7 In the present case, the lumbar abscess likely occurred as a result of a non-hygienic and poor scarification wet cupping procedure. ...
... Whereas positive results are primarily reported in studies conducted in developing countries, published data on the adverse events of wet cupping are often reported in journals of Western origin. [25][26][27] Efforts should be made to promote research collaboration between developing countries and Western countries; particularly countries where wet cupping is still used as a traditional treatment, such as Finland, Poland, Brazil and Korea. Turkey may also be a place where East meets West, and thus may be suitable for conducting in-depth research into CAM. ...
Article
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Hijama means cupping, but in Arab and Muslim culture it refers to wet cupping. At present, there is much controversy around the practice of wet cupping. To evaluate the current scientific evidence for Hijama, specifically wet cupping, we searched for relevant literature using CAM on PubMed, ACP journal club, Cochrane controlled trials register, Cochrane database of systematic reviews, Cochrane methodology register, database of abstracts of reviews of effects, health technology assessment database, Journals@Ovid, MEDLINE and the NHS economic evaluation database. Three systematic reviews investigated the effectiveness of wet and dry cupping. Two of the reviews found some evidence of effectiveness for cupping and pain. Favourable effects were reported for wet cupping when used as an adjuvant to conventional drugs. The third systematic review found very little evidence of effectiveness for cupping and stroke rehabilitation. Other clinical and observational studies were of limited quality. Few randomised controlled trials have examined the effectiveness of cupping (specifically wet cupping), and those that have been published were generally of low quality, with many limitations.
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Iron overload causes iron deposition and accumulation in the liver, heart, skin, and other tissues resulting in serious tissue damages. Significant blood clearance from iron and ferritin using wet cupping therapy (WCT) has been reported. WCT is an excretory form of treatment that needs more research efforts. WCT is an available, safe, simple, economic, and time-saving outpatient modality of treatment that has no serious side effects. There are no serious limitations or precautions to discontinue WCT. Interestingly, WCT has solid scientific and medical bases (Taibah mechanism) that explain its effectiveness in treating many disease conditions differing in etiology and pathogenesis. WCT utilizes an excretory physiological principle (pressure-dependent excretion) that resembles excretion through renal glomerular filtration and abscess evacuation. WCT exhibits a percutaneous excretory function that clears blood (through fenestrated skin capillaries) and interstitial fluids from pathological substances without adding a metabolic or detoxification burden on the liver and the kidneys. Interestingly, WCT was reported to decrease serum ferritin (circulating iron stores) significantly by about 22.25% in healthy subjects (in one session) and to decrease serum iron significantly to the level of causing iron deficiency (in multiple sessions). WCT was reported to clear blood significantly of triglycerides, low-density lipoprotein (LDL) cholesterol, total cholesterol, uric acid, inflammatory mediators, and immunoglobulin antibodies (rheumatoid factor). Moreover, WCT was reported to enhance the natural immunity, potentiate pharmacological treatments, and to treat many different disease conditions. There are two distinct methods of WCT: traditional WCT and Al-hijamah (WCT of prophetic medicine). Both start and end with skin sterilization. In traditional WCT, there are two steps, skin scarification followed by suction using plastic cups (double S technique); Al-hijamah is a three-step procedure that includes skin suction using cups, scarification (shartat mihjam in Arabic), and second skin suction (triple S technique). Al-hijamah is a more comprehensive technique and does better than traditional WCT, as Al-hijamah includes two pressure-dependent filtration steps versus one step in traditional WCT. Whenever blood plasma is to be cleared of an excess pathological substance, Al-hijamah is indicated. We will discuss here some reported hematological and therapeutic benefits of Al-hijamah, its medical bases, methodologies, precautions, side effects, contraindications, quantitative evaluation, malpractice, combination with oral honey treatment, and to what extent it may be helpful when treating thalassemia and other conditions of iron overload and hyperferremia.
Article
Cupping therapy (CT) is one of the oldest medical techniques available, and is still used in several cultures instead of or as an adjunct or complement to 'western academic' medicine. Moreover, CT (wet or dry) is claimed to have therapeutic effects in many types of disorders which do not fully respond to conventional medicine or for which no effective treatment is available. However, no recent reviews of the clinical practice of cupping are available to the best of our knowledge. We describe the applications of CT as used in Traditional Iranian Medicine (TIM). Several databases were searched for relevant literature. In addition, we studied the main traditional treatises on TIM regarding the history and practice of CT. Information about current practices was obtained from a systematic survey among practitioners. Our results suggest that CT is currently prescribed for up to 120 diseases and disorders that are difficult to treat, including cutaneous (21.7%), musculoskeletal (15%), and central nervous system (13.3%) disorders. Moreover, TIM treatises note 25 specific sites on the body surface which correspond to certain diseases, and on which wet-cupping therapy has therapeutic effects. Additional clinical studies of CT may lead to findings on new therapeutic methods and may shed light on mechanisms of disease and illness that are not fully understood in conventional medicine. © 2014 S. Karger GmbH, Freiburg.
Article
A case is reported of skin pigmentation and associated anemia resulting from persistently repeated cupping therapies performed by an unqualified practitioner in South Korea. Almost 30 sessions of excessive cupping therapies with blood loss over two months yielded little benefit but led the patient to admit a hospital and receive blood transfusion for acquired iron deficiency anemia. Skin pigmentation on the cupping-attached region remained without any subjective discomfort. We suggest the importance of qualified health professionals when receiving cupping treatments.
Article
Cupping therapy is an alternative medical procedure that has been widely performed in Asian countries to relieve pain. It is known that there is no complication to this therapy, so many non-health care professionals have performed this procedure. However, there have been few reports on complications, such as iron deficiency anemia, hemorrhagic bullae, kelloids, vasovagal syncope, and foreign body reactions. Masses associated with panniculitis induced by cupping are extremely rare, and they require a unique approach.A 56-year-old woman presented with a 10-month history of multiple masses in the posterior neck and right shoulder areas. The patient repeatedly attempted cupping therapy by herself, and multiple palpable masses developed in the posterior neck and right shoulder area where cupping therapy had been performed. The masses were enlarged by repeated cupping, and they decreased in size when cupping was stopped. Among all lesions, the 2 masses with tenderness were surgically excised. The remaining masses resolved after cupping therapy was ceased. When a patient with subcutaneous mass has a history of cupping or trace of cupping marks, panniculitis induced by cupping should be suspected. The lesion seems to spontaneously resolve unless they are repeatedly stimulated. However, surgical resection is considered in patients with infections or severe tenderness as a complication.
Article
Iron-deficiency anemia (IDA) is the most common nutritional deficiency worldwide. However, the information concerning various causes of IDA in adult men is still insufficient. The aim of our study was to evaluate adult men with IDA. We prospectively studied 206 adult men with IDA. All subjects had a direct history taken and underwent a physical examination. Esophagogastroduodenoscopy was performed in most patients, and colonoscopy was conducted if no lesion causing IDA was found or the fecal occult blood test was positive. The history of prior gastrectomy and blood-letting cupping therapy that probably had caused IDA were reported in 24 (11.7%) and 11 (5.3%) patients, respectively. In terms of potential causes of IDA, 68 (33.0%) patients were found to have upper gastrointestinal disorders (34 peptic ulcers, 17 erosive gastritis, 16 gastric cancers, and one gastrointestinal stromal tumor). Colonoscopy showed 42 (20.4%) clinically relevant lesions that probably caused IDA: colon cancer (five patients), colon polyps (14 patients), ulcerative colitis (one patient), and hemorrhoids (22 patients). One small bowel tumor was detected at small bowel series. Concerning malignant lesions that were responsible for IDA, 22 malignant lesions were found in patients of 50 years or older, accounting for 16.8% (22 of 131 patients), while only one (1.3%) early gastric cancer was found in the younger patients. This study demonstrated that gastrointestinal blood loss is the main cause of IDA in adult men, and that there is a high rate of malignancy in men older than 50 years, emphasizing the need for a complete, rigorous gastrointestinal examination in this group of patients. Considering blood-letting cupping therapy, there is a need to consider culture-specific procedures as a possible cause of IDA.
Article
The effectiveness of the cupping technique, a treatment modality in Traditional Chinese Medicine, in stimulating acupuncture points for pain relief was examined in this paper from a biomechanical perspective. Parametric studies including the effects of vacuum pressure, loading rate, friction coefficient at the cup-skin interface, and size and shape of the cup were carried out using a model based on the finite-element method. The anatomical structures of skin, fat, and muscle were modelled. All the soft-tissue layers were assumed to be nonlinearly elastic and viscoelastic. The rim of the cup was also modelled to study the interaction between cup and skin; the cup rim was assumed to be rigid. The simulation results showed that the stresses in the soft tissue were increased for increasing applied vacuum pressures and that the effects of cupping were mostly limited to the region enclosed by the cup. The simulations also indicated that the magnitude of the applied vacuum may have had direct implications for the severity of bruising of the skin following cupping treatment. Most significantly, the simulation results contradicted the established practice of cup size selection according to the depth of the disorder. Experimental verification of the proposed multi-layered finite-element model is presented. The nature of the bruising inherent to the cupping treatment is also explained by the proposed model.
Article
In women, iron deficiency anemia-a result of chronic iron loss-is most common during the reproductive years because of physiologic demands such as menstrual blood losses and pregnancy. In other cases, iron deficiency anemia is generally attributed to occult gastrointestinal bleeding. Common causes of chronic gastrointestinal blood loss include erosive esophagitis, gastric and duodenal ulcers, vascular ectasias, colon adenomas, and cancers. Bleeding from the small intestine at sites beyond the duodenal bulb is uncommon. The lesions of the small intestine are responsible for approximately 4% of gastrointestinal bleeding [7]. In this report we describe a case of persistent iron deficiency anemia due to carcinoid tumor of the small intestine.
Article
A recent clinical case at the Freiburg University Hospital, Germany, involving burn injuries sustained by cupping treatments is reviewed. The history of the cupping method, indications and contemporary use of this treatment, and the risks from the standpoint of the plastic surgeon are discussed.
Article
The prevalence of iron deficiency anemia is 2 percent in adult men, 9 to 12 percent in non-Hispanic white women, and nearly 20 percent in black and Mexican-American women. Nine percent of patients older than 65 years with iron deficiency anemia have a gastrointestinal cancer when evaluated. The U.S. Preventive Services Task Force currently recommends screening for iron deficiency anemia in pregnant women but not in other groups. Routine iron supplementation is recommended for high-risk infants six to 12 months of age. Iron deficiency anemia is classically described as a microcytic anemia. The differential diagnosis includes thalassemia, sideroblastic anemias, some types of anemia of chronic disease, and lead poisoning. Serum ferritin is the preferred initial diagnostic test. Total iron-binding capacity, transferrin saturation, serum iron, and serum transferrin receptor levels may be helpful if the ferritin level is between 46 and 99 ng per mL (46 and 99 mcg per L); bone marrow biopsy may be necessary in these patients for a definitive diagnosis. In children, adolescents, and women of reproductive age, a trial of iron is a reasonable approach if the review of symptoms, history, and physical examination are negative; however, the hemoglobin should be checked at one month. If there is not a 1 to 2 g per dL (10 to 20 g per L) increase in the hemoglobin level in that time, possibilities include malabsorption of oral iron, continued bleeding, or unknown lesion. For other patients, an endoscopic evaluation is recommended beginning with colonoscopy if the patient is older than 50.